Ben Zeno, Casa de Salud's mental health coordinator, stands in the clinic's lobby. Since it's opened in 2018, the clinic has provided low-cost or free therapy to more than 300 people.

Sarah Fentem | St. Louis Public Radio

After years of preparation, Casa de Salud, the low-cost clinic for uninsured immigrants and refugees, is providing mental health services to 100 people a month.

Early last year, the clinic opened a mental health facility in a renovated mechanic’s garage. To help staff the facility, it provides free clinic space to budding counselors who take on Casa de Salud patients as part of their caseload.

That brings mental health care to patients who need help but often can't obtain it because there aren't enough available therapists or because they don't speak English, have insurance or transportation.

“We provide all the support series, because we found there’s a huge problem of access for our clients,” said Ben Zeno, the mental health coordinator at Casa de Salud. “The fact that they’re seen on-site in our building makes people feel a lot more comfortable.”

Many immigrants or refugees need help processing sometimes traumatic experiences that brought them to the U.S., Casa de Salud President Jorge Riopedre has said. Even if they haven’t been through conflict, living far away from home and trying to adjust to a new culture can be difficult.

That makes access to mental health care for non-native English speakers vital and one of the reasons why the clinic made mental health care a priority.

When examining the problem of access, Casa de Salud looked at another problem, something Zeno called the “private practice gap.” Many counselors and therapists want to open a private practice but few end up following through, largely because they could not afford to rent office space, he said.

“When we look at both of those things, we figure, 'What can we do to make it easier for people to build up their caseload and their private practice here in St. Louis?'” he said. “And also, 'How can we bolster the culturally competent offerings for counseling people?'”

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The Casa de Salud clinic has 20 to 25 therapists, depending on the month.

Only two of those therapists are from Casa de Salud, Zeno said. The other therapists are counselors in training from nearby universities, professionals from other nonprofits or private-practice physicians.

Six of the therapists work in the Casa de Salud “incubator,” the nickname given to the free office-sharing agreement. To receive the free office space, they must provide free or low-cost services to the clinic’s clients, which must be at least 25% of a therapist’s caseload.

It would have been difficult to start a private practice without the free office space, said Moyenda Anwisye, who began seeing patients at Casa de Salud in October.

He works part time at the clinic in addition to his full-time job as a school district counselor. His caseload includes two clients, two of whom are Casa de Salud patients.

The business side of starting his own business was somewhat daunting, he said.

“We begin to put a lot of different barriers in front of us,” he said. “What the arrangements with Casa does is it takes one of those barriers out, and that’s space.”

The clinic handles referrals and transportation for patients at Casa de Salud. which is at Compton and Chouteau, near St. Louis University Hospital. If needed, it can provide interpreters through its partners at LAMP, a St. Louis nonprofit. Counselors also meet to discuss problems and solutions at monthly case meetings and get advice on how to connect with their clients from different cultures.

Many of the problems he sees in his Casa de Salud patients are similar to what he’s experienced in working with kids in St. Louis as a school counselor, Anwisye said. Patients have issues with anxiety and depression or problems communicating with family members. But immigrants and refugees often have had troubling experiences that his other clients with the same mental health issues do not have to grapple with.

“There are root problems, root issues, that all people deal with,” Anwisye said. “They may come from or show up differently in different people, and that’s what I hope to better understand as I continue to connect."

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